Dependence on opioid drugs is associated with a range of health and social problems that affect individual drug users, their family and friends, and the wider public.

What are opioid drugs?

Opioids are chemical substances that have a morphine-type action in the body. They are most commonly used for pain relief, but they are addictive and can lead to drug dependence. They include:

  • opiates—drugs naturally derived from the opium poppy, such as codeine and heroin
  • semi-synthetic opiates, such as hydromorphone and oxycodone
  • opioids, such as fentanyl and methadone.

Opioid drugs can be:

  • illicit opioids, predominantly heroin
  • prescription opioids (whether prescribed for the person or obtained illicitly) such as morphine and oxycodone (Roxburgh A et al. 2011)

Since 1 February 2018, access to all medicines containing codeine has required a prescription.

What is opioid drug dependence?

Drug dependence is characterised by drug seeking and using, but people experience it in various ways. The International statistical classification of diseases and related health problems, 10th revision (ICD-10) (WHO 2010) defines 'dependence syndrome' due to the use of opioids as:

'A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state (Code F11.2).'

What problems can opioid dependence cause?

Opioid drug use and dependence is associated with a range of health and social problems including:

  • loss of life through overdose
  • medical and mental health consequences, including transmission of hepatitis C, hepatitis B and HIV
  • social consequences to individuals and their communities, including impact on relationships, employment, education, housing, parenting, finances and crime (NSW Clinical Guidelines: Treatment of Opioid Dependence 2018).

What treatment is available?

Opioid pharmacotherapy treatment is one of the main treatment types used for opioid drug dependence and involves replacing the opioid drug of dependence with a legally obtained, longer-lasting opioid that is usually taken orally.

Opioid pharmacotherapy treatments (such as methadone or buprenorphine) can:

  • reduce drug cravings and withdrawal symptoms
  • improve physical and mental health, social functioning and economic participation
  • reduce drug-related crime (Ritter A & Chalmers J 2009).

In Australia, 3 medications are registered for long-term maintenance treatment for opioid-dependent people:

  • methadone
  • buprenorphine
  • buprenorphine-naloxone.

Opioid pharmacotherapy treatment is administered according to the law of the relevant state or territory, and within a framework that includes medical, social and psychological treatment. The Australian Government Department of Health, as part of the National Drug Strategy, published the National Guidelines for Medication-Assisted Treatment of Opioid Dependence (DoH 2014) to provide a broad policy context and framework for state and territory policies and guidelines that are concerned with the medication-assisted treatment of opioid dependence.

What is the NOPSAD collection?

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection is compiled from jurisdictional data and provides information about:

  • clients receiving opioid pharmacotherapy treatment;
  • the health professionals prescribing opioid pharmacotherapy drugs; and
  • the dosing points (such as pharmacies) that clients attend to receive their medication.

Data are reported on a snapshot day in June each year. The snapshot day varies across jurisdictions. This is because each state and territory uses a slightly different method to collect data. These are driven by jurisdictional differences, such as legislation, computer systems and resources. These differences may result in minor discrepancies when comparing one jurisdiction to another.

References

DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoH for National Drug Strategy. Viewed 23 December 2019.

NSW Clinical Guidelines: Treatment of Opioid Dependence – 2018. PDF Download viewed 23 December 2019.

Ritter A & Chalmers J 2009. Polygon: the many sides to the Australian opioid pharmacotherapy maintenance system. ANCD research paper no. 18. Canberra: Australian National Council on Drugs.

Roxburgh A, Bruno R, Larance B & Burns L 2011. Prescription of opioid analgesics and related harms in Australia. Medical Journal of Australia 195:280–284.

WHO (World Health Organization) 2010. Mental and behavioural disorder due to the use of opioids: dependence syndrome. ICD-10: International statistical classification of diseases and related health problems. Viewed 23 December 2019.